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Study of GVAX (With CY) and Pembrolizumab in MMR-p Advanced Colorectal Cancer

Primary Purpose

Metastatic Colorectal Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
CY
GVAX
Pembrolizumab
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Colorectal Cancer focused on measuring Colorectal Neoplasms, Gastrointestinal Neoplasms, Digestive System Neoplasms, Neoplasms by Site, Neoplasms, Digestive System Diseases, Gastrointestinal Diseases, Intestinal Diseases, Rectal Diseases, Colonic Diseases

Eligibility Criteria

18 Years - 100 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Documented mismatch repair-proficient cancer of colorectum, who have received at least two prior lines of therapy for metastatic disease
  2. Measurable disease by RECIST v1.1
  3. Age >18 years
  4. ECOG Performance Status of 0 to 1
  5. Estimated life expectancy of greater than 3 months.
  6. Adequate organ function as defined by study-specified laboratory tests
  7. Must use acceptable form of birth control through the study and for 120 days after final dose of study drug
  8. Signed informed consent form
  9. Willing and able to comply with study procedures

Exclusion Criteria:

  1. Has a known additional malignancy that is progressing or requires active treatment.
  2. Has known central nervous system (CNS) metastases and/or carcinomatous meningitis.
  3. Has known malignant small bowel obstruction within the last 6 months.
  4. Currently have or have history of certain study-specified heart, liver, kidney, lung, neurological, immune or other medical conditions.
  5. Systemically active steroid use.
  6. Has an active infection requiring systemic therapy.
  7. Has a known history of active TB (Bacillus Tuberculosis).
  8. Infection with HIV or hepatitis B or C.
  9. Has history of (non-infectious) pneumonitis that required steroids.
  10. Must not require supplemental oxygen or have a pulse oximetry < 92% on room air.
  11. Conditions, including therapy, laboratory abnormalities, psychiatric or substance abuse disorders, intercurrent illness, or lack of sufficient peripheral venous access, that would affect the patient's ability to comply with study visits and procedures.
  12. Pregnant or lactating.
  13. Another investigational product within 28 days prior to receiving study drug.
  14. Major surgery or significant traumatic injury (or unhealed surgical wounds) occurring within 28 days prior to receiving study drug.
  15. Chemotherapy, radiation, hormonal, or biological cancer therapy within 28 days prior to receiving study drug.
  16. Has received a live vaccine within 30 days of planned start of study therapy.
  17. Prior treatment with immunotherapy agents (including, anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA4, etc.).
  18. Patients receiving growth factors including, but not limited to, granulocyte-colony stimulating factor (G-CSF), GM-CSF, erythropoietin, within 14 days of study drug administration.
  19. Hypersensitivity to pembrolizumab or any of its excipients.
  20. Patient has a known or suspected hypersensitivity to GM-CSF, hetastarch, corn, dimethyl sulfoxide, fetal bovine serum, trypsin (porcine origin), yeast or any other component of GVAX vaccine.
  21. Presence of any tissue or organ allograft and history of allogeneic hematopoietic stem cell transplant.
  22. Unwilling or unable to comply with study procedures.

Sites / Locations

  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

CY/GVAX with Pembrolizumab

Arm Description

During each 21 day cycles, Cyclophosphamide (CY) is administered on Day 1 at 200 mg/m2 followed by Pembrolizumab at 200mg, the colon cancer vaccine (GVAX) is administered on Day 2 at 5E8 colon cancer cells + 5E7 GM-CSF secreting cells for the first 4 cycles of treatment. After cycle 4, cyclophosphamide and GVAX will be administered with every 4th cycle.

Outcomes

Primary Outcome Measures

Objective Response Rate (ORR)
ORR is defined as the number of patients achieving a complete response (CR) or partial response (PR) based on the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) at any time during the study. CR = disappearance of all target lesions, PR is =>30% decrease in sum of diameters of target lesions, progressive disease (PD) is >20% increase in sum of diameters of target lesions, stable disease (SD) is <30% decrease or <20% increase in sum of diameters of target lesions.

Secondary Outcome Measures

Number of Participants With Adverse Events as a Measure of Safety and Tolerability
Number of participants who experience treatment related adverse events ≥ grade 3 as defined by CTCAE 4.0.
Progression Free Survival (PFS)
Progression-free Survival (PFS) is defined as the number of days from cycle 1, day 1 of immunotherapy until first documented local progression or death due to any cause. PD is >20% increase in sum of diameters of target lesions as assessed using RECIST (version 1.1).
Overall Survival (OS)
OS is defined as the number of days from start of study treatment to time of death. Individuals will be censored at the date of the last study visit if no event occurs. The estimation method used was Kaplan-Meier.
Duration of Response (DOR)
Number of weeks from the start date of PR or CR (whichever response is recorded first) and subsequently confirmed to the first date that recurrent or progressive disease or death is documented. Per RECIST 1.1, CR = disappearance of all target lesions, PR is =>30% decrease in sum of diameters of target lesions.

Full Information

First Posted
December 1, 2016
Last Updated
February 8, 2021
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT02981524
Brief Title
Study of GVAX (With CY) and Pembrolizumab in MMR-p Advanced Colorectal Cancer
Official Title
A Phase 2 Study of GVAX Colon Vaccine (With Cyclophosphamide) and Pembrolizumab in Patients With Mismatch Repair-Proficient (MMR-p) Advanced Colorectal Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Completed
Study Start Date
May 26, 2017 (Actual)
Primary Completion Date
March 20, 2018 (Actual)
Study Completion Date
March 20, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will be looking at the objective response rate (ORR) as measured by RECIST in in patients with mismatch repair-proficient (MMR-p), advanced colorectal cancer that treated with CY/GVAX in combination with Pembrolizumab.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Colorectal Cancer
Keywords
Colorectal Neoplasms, Gastrointestinal Neoplasms, Digestive System Neoplasms, Neoplasms by Site, Neoplasms, Digestive System Diseases, Gastrointestinal Diseases, Intestinal Diseases, Rectal Diseases, Colonic Diseases

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CY/GVAX with Pembrolizumab
Arm Type
Experimental
Arm Description
During each 21 day cycles, Cyclophosphamide (CY) is administered on Day 1 at 200 mg/m2 followed by Pembrolizumab at 200mg, the colon cancer vaccine (GVAX) is administered on Day 2 at 5E8 colon cancer cells + 5E7 GM-CSF secreting cells for the first 4 cycles of treatment. After cycle 4, cyclophosphamide and GVAX will be administered with every 4th cycle.
Intervention Type
Drug
Intervention Name(s)
CY
Other Intervention Name(s)
Cyclophosphamide, Cytoxan
Intervention Description
CY is administered intravenously at 200 mg/m2
Intervention Type
Biological
Intervention Name(s)
GVAX
Other Intervention Name(s)
Colon cancer vaccine
Intervention Description
GVAX is administered intradermally at 5E8 colon cancer cells + 5E7 GM-CSF secreting
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Other Intervention Name(s)
KEYTRUDA, MK-3475
Intervention Description
Pembrolizumab is administered intravenously at 200 mg
Primary Outcome Measure Information:
Title
Objective Response Rate (ORR)
Description
ORR is defined as the number of patients achieving a complete response (CR) or partial response (PR) based on the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) at any time during the study. CR = disappearance of all target lesions, PR is =>30% decrease in sum of diameters of target lesions, progressive disease (PD) is >20% increase in sum of diameters of target lesions, stable disease (SD) is <30% decrease or <20% increase in sum of diameters of target lesions.
Time Frame
up to 1 year
Secondary Outcome Measure Information:
Title
Number of Participants With Adverse Events as a Measure of Safety and Tolerability
Description
Number of participants who experience treatment related adverse events ≥ grade 3 as defined by CTCAE 4.0.
Time Frame
up to 1 year
Title
Progression Free Survival (PFS)
Description
Progression-free Survival (PFS) is defined as the number of days from cycle 1, day 1 of immunotherapy until first documented local progression or death due to any cause. PD is >20% increase in sum of diameters of target lesions as assessed using RECIST (version 1.1).
Time Frame
up to 1 year
Title
Overall Survival (OS)
Description
OS is defined as the number of days from start of study treatment to time of death. Individuals will be censored at the date of the last study visit if no event occurs. The estimation method used was Kaplan-Meier.
Time Frame
Up to 1 year
Title
Duration of Response (DOR)
Description
Number of weeks from the start date of PR or CR (whichever response is recorded first) and subsequently confirmed to the first date that recurrent or progressive disease or death is documented. Per RECIST 1.1, CR = disappearance of all target lesions, PR is =>30% decrease in sum of diameters of target lesions.
Time Frame
1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
100 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Documented mismatch repair-proficient cancer of colorectum, who have received at least two prior lines of therapy for metastatic disease Measurable disease by RECIST v1.1 Age >18 years ECOG Performance Status of 0 to 1 Estimated life expectancy of greater than 3 months. Adequate organ function as defined by study-specified laboratory tests Must use acceptable form of birth control through the study and for 120 days after final dose of study drug Signed informed consent form Willing and able to comply with study procedures Exclusion Criteria: Has a known additional malignancy that is progressing or requires active treatment. Has known central nervous system (CNS) metastases and/or carcinomatous meningitis. Has known malignant small bowel obstruction within the last 6 months. Currently have or have history of certain study-specified heart, liver, kidney, lung, neurological, immune or other medical conditions. Systemically active steroid use. Has an active infection requiring systemic therapy. Has a known history of active TB (Bacillus Tuberculosis). Infection with HIV or hepatitis B or C. Has history of (non-infectious) pneumonitis that required steroids. Must not require supplemental oxygen or have a pulse oximetry < 92% on room air. Conditions, including therapy, laboratory abnormalities, psychiatric or substance abuse disorders, intercurrent illness, or lack of sufficient peripheral venous access, that would affect the patient's ability to comply with study visits and procedures. Pregnant or lactating. Another investigational product within 28 days prior to receiving study drug. Major surgery or significant traumatic injury (or unhealed surgical wounds) occurring within 28 days prior to receiving study drug. Chemotherapy, radiation, hormonal, or biological cancer therapy within 28 days prior to receiving study drug. Has received a live vaccine within 30 days of planned start of study therapy. Prior treatment with immunotherapy agents (including, anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA4, etc.). Patients receiving growth factors including, but not limited to, granulocyte-colony stimulating factor (G-CSF), GM-CSF, erythropoietin, within 14 days of study drug administration. Hypersensitivity to pembrolizumab or any of its excipients. Patient has a known or suspected hypersensitivity to GM-CSF, hetastarch, corn, dimethyl sulfoxide, fetal bovine serum, trypsin (porcine origin), yeast or any other component of GVAX vaccine. Presence of any tissue or organ allograft and history of allogeneic hematopoietic stem cell transplant. Unwilling or unable to comply with study procedures.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nilofer Azad, MD
Organizational Affiliation
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31876399
Citation
Yarchoan M, Huang CY, Zhu Q, Ferguson AK, Durham JN, Anders RA, Thompson ED, Rozich NS, Thomas DL 2nd, Nauroth JM, Rodriguez C, Osipov A, De Jesus-Acosta A, Le DT, Murphy AG, Laheru D, Donehower RC, Jaffee EM, Zheng L, Azad NS. A phase 2 study of GVAX colon vaccine with cyclophosphamide and pembrolizumab in patients with mismatch repair proficient advanced colorectal cancer. Cancer Med. 2020 Feb;9(4):1485-1494. doi: 10.1002/cam4.2763. Epub 2019 Dec 26.
Results Reference
result

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Study of GVAX (With CY) and Pembrolizumab in MMR-p Advanced Colorectal Cancer

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